Fresh frozen plasma ( FFP ) is a blood product made from the liquid part of the whole blood. It is used to treat conditions in which there is a low blood clotting factor (INR & gt; 1,5) or low levels of other blood proteins. It is also used as part of the plasma exchange. A custom batch usually needs to be tested for compatibility before it is given. Use as volume expander is not recommended. This is given by injection into a blood vessel.
Side effects include nausea and itching. Rarely there may be an allergic reaction, blood clots, or infection. It is unclear whether the use during pregnancy or breast-feeding is safe for infants. Better care should be taken in people with protein S deficiency, IgA deficiency, or heart failure. Fresh frozen plasma consists of a complex mixture of water, protein, carbohydrates, fats, and vitamins. When frozen it lasts about a year.
Plasma was first used in medicine during the Second World War. It's in the List of Essential Medicines of the World Health Organization, the most effective and safe drugs needed in the health system. In the United Kingdom it costs around Ã, Â £ 30 per unit. A number of other versions also exist including frozen plasma within 24 hours after the process of removing blood, reducing plasma cryoprecipitate, and solvent detergent plasma.
Video Fresh frozen plasma
Definisi
In the United States it refers to the liquid portion of a centrifugated, separated, and solid frozen human unit at -18 Â ° C (0 Â ° F) or cooler within eight hours of collection. The phrase "FFP" is often used to mean transfused plasma products. Other frequently transfused plasmas, PF24, have similar indications like for FFP with the exception of heat-sensitive proteins in plasma such as factor V.
Maps Fresh frozen plasma
Medical use
Very few specific indications for FFP use. This indication is generally limited to the treatment of coagulant protein deficiencies in which the specific factor concentrates are unavailable or undesirable. In many clinical practices, fresh and frozen plasma contains proteins with two important coagulation factors in them - V and VIII. Other documentation suggests FFP has no beneficial effect when used as a transfusion to stop massive bleeding. In addition, existing circumstances in which FFP has been used and believed to be therapeutic values, but data supporting their efficacy are limited or unavailable (eg, some coagulation protein deficiencies in uncontrolled bleeding patients). Since such patients are often critically ill and satisfactory alternative therapies may not be at hand, FFP may be appropriate.
Indications for use of FFP include the following:
- The replacement of isolated factor deficiency FFP is used to treat rare bleeding disorders when specific factor concentrates are not available. FFP is the usual treatment for factor V deficiency.
- Reversing warfarin effect Patients who were given anticoagulant with warfarin lacked functional function dependent on coagulation factors of vitamin K II, VII, IX, and X, as well as proteins C and S. These functional deficiencies may be reversed by vitamin K. For patients who have anticoagulants actively bleeding or who require Prothrombin concentrates of emergency surgery should be used if available. FFP (or single donor plasma) should only be used if more effective alternative treatments are not available.
- Usage in Antithrombin III deficiency FFP can be used as a source of antithrombin III in patients who are deficient in this inhibitor and are undergoing surgery or who require heparin for thrombosis treatment.
- Treatment of immunodeficiencies FFP is useful in infants with secondary immunodeficiency associated with severe protein loss enteropathy and among which total parenteral nutrition is ineffective. FFP can also be used as a source of immunoglobulins for children and adults with humoral immunodeficiency. However, development of pure immune globulin for intravenous use has largely replaced Fresh frozen plasma
- Treatment of thrombotic thrombocytopenic purpura FFP may be useful for thrombotic thrombocytopenic purpura treatment.
Risk
FFP risks include disease transmission, anaphylactoid reactions, and excessive intravascular volume, as well as transfusions related to acute lung injury (TRALI) and increased infection (including surgical wound infections). The possibility of FFP virus infectivity may be similar to all blood and red blood cells. The level of post-transfusion hepatitis depends on many factors, including the selection of donors. In rare cases, human immunodeficiency virus (HIV) is transmitted through blood transfusions and possibly by FFP. An allergic or anaphylactoid reaction may occur in response to FFP administration and may vary from itching to fatal noncardiogenic pulmonary edema.
FFP should be matched blood type to ensure compatibility, since agglutination reactions may, though rarely. As with any given intravenous fluid, excessive amounts of FFP can cause hypervolemia and heart failure.
Chemistry
FFP is made by centrifugation followed by freezing and preservation.
Usage
The use of plasma and its products has grown for four decades. The use of FFP has increased tenfold in the United States from 2000-2010 and has reached nearly 2 million units per year. This tendency may be due to several factors, possibly including decreased overall blood availability due to wide acceptance of the concept of component therapy.
Alternative
The evidence suggests that other plasma components (eg, single donor plasma) that do not meet the FFP criteria may have adequate coagulation factor levels and are suitable for patients whose FFP is indicated. Plasma single donor efficacious in the treatment of mild deficiency stable clotting factor. It is also a value in the treatment of various deficiencies such as in reversing effects of warfarin or on liver disease.
Safe and effective alternative treatments are often present so that FFP is no longer the preferred therapy under a variety of conditions. Cryoprecipitate should be used when fibrinogen or von Willebrand factor is required. For the treatment of hemophilia A, a cryoprecipitate or factor VIII concentrate, heated or unheated, is available. For the treatment of severe hemophilia B, factor complex IX is preferred. Both concentrates are made from plasma collected, and the risk of viral transmission can be ignored since there has been no infection since 1985 when techniques were developed to kill viruses including HIV. The factor IX concentrate carries additional dangers of thrombogenicity.
A crystalloid solution, a colloid containing human serum albumin or plasma protein fraction, hydroxyethyl starch, and dextran is preferred over FFP for volume replacement. The practice of giving red cells and FFP packaged for the same patient should be discouraged, as this adds to the cost and doubles the infection rate. When the condition is right, all the blood should be given.
For nutritional support, amino acid and dextrose solutions are available. The most important alternative to the use of FFP is a comprehensive program for blood conservation. These include measures such as autologous donations prior to elective surgery, infused blood infusions, and awareness that in many patients normovolemic anemia is not an indication for transfusion.
References
Further reading
- British Committee for Standards in Hematology, Blood Transfusion Task Force (J. Duguid, Chairman); O'Shaughnessy, D. F.; Atterbury, C ;; Bolton Maggs, P.; Murphy, M.; Thomas, D.; Yates, S.; Williamson, L. M. (July 1, 2004). "Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant". British Hematology Journal . 126 (1): 11-28. doi: 10.1111/j.1365-2141.2004.04972.x. ISSNÃ, 1365-2141 . Retrieved October 3 2016 .
External links
- NIH Consensus Development Program: Fresh Frozen Plasma: Indication and Risk (public domain)
- Circular information describing the use of transfusion products in the United States
Source of the article : Wikipedia
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